at substance abuse in pregnancy.

All the statistics are Canad-

ian/North American, which, for this topic, makes it less easy
for others to relate to, and much of the advice for medical
care is generic, not especially related to the pregnant
woman. Chapter 6 tackles ultrasound, how it works and
how to do it. It is a good account, while not being limited
to the possibly controversial place of ultrasound in obstetric
anaesthesia. The chapter is based on practice in the UK,
and I wonder how it applies to colleagues in North
America. Chapter 3 covers pre-eclampsia, but I found the
initial terminology confusing. This is an important topic
which trainees nd difcult, so we must get it right for
them. Unfortunately, this chapter fails in this respect.
Chapter 2 is an excellent review of cardiac disease in preg-
nancy and Chapter 4 gives a comprehensive account of
obstetric haemorrhage and its management at a level of suf-
cient detail to be interesting to those more experienced but
also of use to trainees. The latter is relatively UK-based in its
advice, and some elements (e.g. prophylactic arterial
balloons) could be argued still to be controversial, requiring
more discussion. Chapter 8 is well written, covering the
pros and cons of regional analgesia in the light of
coagulopathies.
Chapter 9 looks at air vs saline for the identication of the
epidural space and is a beautifully constructed text, with a
rm recommendation at the end to teach residents to use
saline. Another chapter looks at ambulatory epidural anal-
gesia and even for those of us well versed in its use, it is
worth reading. The following chapter comprehensively
tackles the ephedrine vs phenylephrine question. The
chapter on oxytocin usage is also very good, quoting inter-
national usage and data. Of those less controversial topics,
Chapter 19 looks at the need for/use of oxygen supplemen-
tation at regional block for Caesarean section; while not a
controversy, the discussion is well argued. Another chapter
covers analgesia post-section, hardly controversial as such
but it does not mention intrathecal/epidural diamorphine
as an option (although Chapter 14 does). This is a pity as it
causes substantially less nausea and vomiting than mor-
phine and is in widespread use outside of North America.
Indeed, a controversial point is whether morphine should
be used at all in this situation.
In summary, this book is easy to read and on the
whole contains good information, but is a bit of a mixed
bag, being somewhat limited by the differences in clinical
practice on the two sides of the Atlantic. This aspect is
not good for those new to the eld and it is for this
group for whom the book is primarily intended. For the in-
formation this book does contain, and at this price, it
would be a useful addition to a departmental bookshelf,
but may need guidance from senior staff in its
interpretation.
S. Coley
Leicester, UK
E-mail: coley.sue@gmail.com
doi:10.1093/bja/aes190
Anesthesia Outside of the Operating Room.
R. D. Urman, W. L. Gross and B. K. Philip (editors). Pub-
lished by Oxford University Press, Oxford, UK. Pp. 360;
indexed; illustrated. Price 70.00. ISBN 978-0-19-
539667-6.
A senior theatre nurse who enjoyed hunting and shing
once said that if you want to know what the local
weather is going to be like, you should check the weather
2 weeks previously in the USA. Much the same can be
said of medical matters. There is an increasing demand to
provide anaesthesia for patients undergoing procedures
outside the operating theatre. Technological advances and
an ageing population have increased the demand for
complex diagnostic procedures and minimally invasive sur-
gical interventions. This book deals with the topic from a
North American perspective but does give insight into the
challenges that are being presented to anaesthetists on
this side of the Atlantic.
The 360 pages of this A4 size hardback textbook are
divided into 33 chapters and three appendices. The rst
eight chapters deal with general topics such as the chal-
lenges of anaesthesia outside the operating theatre, pre-
operative evaluation, monitoring, anaesthetic techniques,
and recovery. Management of stafng and scheduling,
sedation by non-anaesthetists and issues relating to
outcome, regulation, and quality improvement are
discussed.
The remaining chapters deal, in a detailed and informative
way, with anaesthetic requirements in specic, familiar envir-
onments such as interventional radiology, magnetic reson-
ance imaging, gastrointestinal endoscopy, urology, and
electroconvulsive therapy. Somewhat less familiar areas
that are discussed include Anesthesia for Interventional Pul-
monology, In Vitro Fertilization, and Natural Orice Trans-
luminal Endoscopic Surgery. It is interesting that
anaesthesia in the cardiac catheterization laboratory is
dealt with in a chapter entitled New Challenges for Anaes-
thesiologists Outside the Operating Room. The increasing
demands for an anaesthetic presence during percutaneous
coronary interventions are dealt with in detail. The debate
exists in many hospitals in the UK as to whether cardiac
anaesthetists or non-cardiac anaesthetists should be
involved during invasive interventions by cardiologists. This
book gives sound advice regarding the maximization of
patient safety as a result of collaboration and planning
between cardiologists and anaesthetists. A common knowl-
edge base and mutual respect for each contributing discip-
line is essential.
Some chapters do have a denite North American avour,
for example Ofce Based Anesthesia, Ultra-Rapid Opiate
Detoxication, and Anesthetic Considerations in Homeland
Disasters. While less relevant to UK practice, they do make
interesting reading. The chapter on Anesthesia Considera-
tions in Dental Practice describes administration of local
anaesthesia that usually would be the province of the
dentist.
BJA Book reviews
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From a trainees point of view, this book will provide the
answer to any examination questions that relate to non-
operating theatre anaesthesia. However, all references are
from North America and different guidelines will apply in
Europe. This is a developing eld and there will be an increasing
exposure of trainees to anaesthesia outside theatres. It will
provide insight into what is to be expected during a fellowship
year in North America. There is a concise chapter on anaesthe-
sia in the emergency department that will be useful to trainees.
We feel that this book would have been improved if illustra-
tions were not in black and white. Images from the radiation
oncology suite, for example, would be more informative if
they were in colour. The multiple-contributor format has
resulted in repetition of topics such as pharmacology of seda-
tive agents and pre-assessment.
Anaesthetists, who are trying to cope with the increasing
demands of anaesthesia outside the operating theatre, will
nd this a useful resource that will assist in proving the
need for adequate resources. It could be waved at hospital
managers and clinical colleagues whose practice will
benet from anaesthetic support.
P. A. Farling and R. Haughey
Belfast, UK
E-mail: peter.farling@dnet.co.uk
doi:10.1093/bja/aes191
Book reviews BJA
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